ComD 10/31/13

• when vocal quality deteriorates in the absence of anatomic and neurological factors, there may be a functional disorder
• nothing looks wrong with them

• symptoms will come and go
• treat with laryngeal massage
• more common in women

• usually in men
• when a boy's voice changes during puberty, the structure changes
• they speak really high
• can be treated by laryngeal massage

• Vagus Nerve Lesion
• Spasmodic dysphonia
• ALS
• Parkinson's
• latrogenic etiology
• Vocal tic, Tourette Syndrome

• Tracheostomy
• Laryngectomy

• Strobe
• Oral peripheral
• Medical referral
• Case history
• Clinical observation
• Listen for quality, loudness, pitch, etc.

• respiration- adequate breath support
• relaxation training

• limit vocal abuse
• stop yelling, screaming, anything done with
• excess tension
• reduce loudness
• stop smoke exposure
• drinking is bad too
• granulomas- diet and medication for GERD

• iffy
• difficult
• must have SLP as well, or precipitating
• factors will still be there

• botox for spasmodic dysphonia
• other meds for other conditions

• phonation
• resonance
• frequency
• intensity

producing sound by sending air through vocal folds

what happens to shape or sound after its produced in vocal folds

• the number of times the vocal folds oscillate 
• the more they vibrate- the higher our pitch
• the less they vibrate- the lower our pitch

how much air we send through those vocal folds; how loud

• normal pitch
• you use it the most

the most healthy pitch for a person to use

lowest pitch your voice can produce

highest pitch your voice can produce

difference between ceiling and basal pitch

• determined by volume
• can be too loud (yelling)
• can be too soft

voice differs in pitch, loudness, and/or quality compared to persons of a similar age, background, race, ethnicity to the extent that it calls negative attention to the speaker and/or interferes with communication

6

29%

women; men (7% vs 5%)

• vocal nodules 22%
• edema 14%
• polyps 11%
• carcinoma 10%
• vocal fold paralysis 8%
• unknown 10%
• other stuff

• 4-6% of kids have some
• problems with voice
• most common cause vocal nodules
• more than 1 million kids develop nodules annually

• hard glottal attack
• glottal fry (tightly
• approximated folds)
• breathy phonation (aphonia)
• spasticity or strain (too much tension, stoppage)
• diplophonia- random pitch breaks
• hoarseness (noise introduced-lose higher frequencies)- strain+breathiness

• structural- when something is wrong in the vocal folds
• functional- in the way you use your voice
• neurogenic- neurological cause for voice disorder

• What are they?
• -small, bilateral, callous growths or protuberances on inner edges of vocal folds
• you can't do surgery on them
• bilateral
• sounds scratchy

• vocal abuse
• over singing
• singing the wrong way
• yelling, screaming, cheering, etc.
• basically, too much tension, hard attacks
• talking or yelling when you have a cold, etc.

• unilateral
• can do surgery
• tend to be more
• vascular
• broad term for a "protruding growth from a mucous membrane" (Dorland's 1988)
• change mass of folds
• may change approximation
• hoarse, breathy voice
• fold polyps

• contact ulcers are inflamed lesions or ulcers
• posterior part of pharynx on arytenoid cartilages-sores

• forceful contact (repeated), tissue dies
• body forms a granuloma at site of ulcer
• folds can't approximate- no smooth surface
• may result from GERD (gastroesophageal reflux disease)- acid reflux, heartburn- acid backs up into esophagus